In the Western World,
people usually do not make a distinction between illness and disease.
These two terms seem to mean essentially the same thing and are often used
interchangeably. However, it is important to define illness and
disease differently when considering some non-western cultural traditions.
Disease is an objectively measurable
pathological
condition of the body. Tooth decay, measles, or a
broken bone are examples. In contrast, illness is a feeling of not
being normal and healthy. Illness may, in fact, be due to a disease.
However, it may also be due to a feeling of psychological or spiritual
imbalance. By definition, perceptions of illness are highly culture
related while disease usually is not. It is important for health
professionals who treat people from other cultures to understand what their
patients believe can cause them to be ill and what kind of curing methods they
consider effective as well as acceptable. Understanding a culture's
perception of illness is also useful in discovering major aspects of their
world view.

What Causes Illness?

How illness is explained often varies
radically from culture to culture. Likewise, the methods considered
acceptable for curing illness in one culture may be rejected by another.
These differences can be broadly generalized in terms of two explanatory
traditions--naturalistic and personalistic.

Naturalistic
Explanation

The Western World now mostly relies
on a naturalistic
explanation of illness. This medical tradition had its beginnings in ancient
Greece, especially with the ideas of Hippocrates in the 4th and 5th centuries
B.C. However, it did not begin to take its modern form until the 16th
century A.D.

The naturalistic explanation assumes
that illness is only due to impersonal,
mechanistic causes in nature that can be potentially understood and cured by the application of the
scientific method of discovery.
Typical causes of illness accepted in naturalistic medical systems include:

Students learning to be doctors or
nurses in
medical schools throughout the modern world are taught this kind of
naturalistic explanation. However, there are actually several different
naturalistic medical systems in use today. In Latin America, many people
still also rely on humoral pathology
to explain and cure their
illnesses. This is especially true in rural areas among less educated
people. To learn more
about this alternative medical system, click the button below.

Naturalistic medical systems similar
to European humoral pathology were developed independently in India (Ayurvedic system
) and China
(acupuncture
and herbal medicine
).

Personalistic Explanation

Much of the non-western world traditionally accepted a
personalistic explanation for illness. Today, it is mostly found
among people in small-scale societies
and some subcultures of larger nations. For them, illness is seen as
being due to acts or wishes of other people or supernatural beings and
forces. There is no room for accidents. Adherents of personalistic medical systems believe that the causes and cures
of illness are not to be found only in the natural world. Curers usually
must use supernatural means to understand what is wrong with their patients
and to return them to health. Typical causes of illness in personalistic
medical systems include:

1.

intrusion of foreign objects into the body by
supernatural means

2.

spirit possession, loss, or damage

3.

bewitching

The intrusion of foreign objects was
a common explanation among many Native American cultures for internal body
pains such as headaches and stomachaches. The presumed foreign objects
could be rocks, bones, insects, arrowheads, small snakes, or even supernatural
objects. It was believed that they were intentionally put into an
individual's
body by witchcraft or some other supernatural means. The fact that there
was no wound in the skin for the entry of the objects was consistent with the
belief that supernatural actions were involved. The cure for this class
of
illness was the removal of the object by a shaman.
This usually involved a lengthy non-surgical procedure that was both medical
and religious. Typically, the shaman would appeal to supernatural
spirits for assistance, manipulate the patient's body, blow
tobacco smoke over the site of the pain, and suck on the skin over the pain
with a tube or by mouth to remove the object.
However, there would be no incision made in the skin.

It is easy for people who only accept
a naturalistic explanation for illness to reject the concept of the intrusion
of foreign objects into the body by supernatural means. However, it is
of value to keep in mind that this
explanation is similar to the "germ theory" that is readily accepted by
most people in the western world today. Both explanations require the
belief in something that cannot be seen by most people. In both cases,
there is an act of faith. During the late 19th and early 20th centuries, it
was difficult for microbiologists and physicians such as Louis Pasteur, Joseph
Lister, and Robert Koch to convince the medical profession that bacteria and
other microorganisms can cause infection and disease. It took even
longer for the general public in Europe and North America to be convinced that
there are harmful microscopic "germs."

Susto

In personalistic medical systems,
spirit possession, loss, or damage are seen as the result of actions by
supernatural beings or people. They may also be due to certain kinds of
unpleasant or shocking social situations. An example of this kind of illness is found among
some Hispanics in the United States and Latin America. It is called susto,
which literally means fright or sudden
fear in Spanish. The fear is of losing one's soul. Susto is also referred to as
perdida de la sombra
(literally,
loss of the shadow). This latter name is likely a reference to the
fact that people who do not have souls do not have shadows or reflections in
mirrors, like Hollywood movie vampires. Susto results from
incidents that have a destabilizing effect on an individual, causing the soul
(espiritu)
to leave the body. Typical incidents that can cause susto include:

1.

the sudden, unexpected barking of a dog

2.

being thrown from a horse

3.

tripping over an unnoticed object

4.

sharing a hospital ward with a patient who has died
during the night

5.

having a nighttime encounter with a ghost who keeps
your spirit from
finding its way back into your body before you wake

6.

being socially impinged upon by society (e.g., being
forced to do
something that you do not want to do)

7.

being in a social situation that causes you to have
fear or anger

Common symptoms of susto are restlessness during sleep as
well as being listless and weak when awake. In addition, individuals who
have susto are likely to lack an appetite and to not be interested in their
personal appearance. These symptoms are characteristic of what western
trained medical professionals would likely attribute to excessive emotional
stress or even clinical depression. Traditionally, susto is cured
with a ritual carried out by a curandero (i.e., a folk curer). Among the Maya
Indians of Southern Mexico and Guatemala, this ceremony typically involves a
lengthy series of ritual actions in the presence of the patient's friends and
relatives. It usually begins with prayers to the Catholic saint of the
village. Next, a chicken egg and special herbs are passed over the patient's body to absorb
some of the illness. Later, the egg may be left where the soul loss occurred,
along with gifts to propitiate the supernatural being who has the patient's
soul. The patient is then partly stripped and "shocked" by liquor being
sprayed from the curandero's mouth. The patient may then
be massaged and finally "sweated" on a bed placed over or near a hot stove.
Alternatively, the patient may be covered with many blankets to induce profuse
sweating.

Guatemalan Maya woman

In traditional Hispanic communities
of the Southwestern United States, susto is likely to be treated in a
similar manner by a curandero. The curing ceremony is called a barrida or "sweeping", which is a reference to a bundle of fresh herbs
being swept over the patient's body. However, the cure for mild cases of
susto is likely to be medicine taken orally. Teas made from an
infusion of marijuana, orange blossoms, and brazil wood are commonly used for
this purpose.

Evil Eye

Another common type of soul loss in
Latin America and around the Mediterranean Basin is the
"evil eye" or mal de ojo in Spanish. This illness results from the
perception that some people are "stronger" than others and that their strength
can harm "weak" people. In traditional Mexican and Central
American culture, women,
babies, and young
children are thought of as being weak, while
men as well as rich and politically powerful people of either gender are strong. When a
strong person stares at a weak individual, the eyes of the strong person can
drain the power and/or soul from the weak one. Proof that this may have
occurred to someone is that he or she cries inconsolably without a cause,
has fitful sleep, diarrhea, vomiting, and/or a fever. It is thought
that powerful
people can cause this draining of the soul intentionally or unintentionally.
As a result, parents must guard their children and women must be careful when
interacting with government officials, rich city people, foreign tourists, and
machos in general. The traditional cure for
mal de
ojo in rural Mexico often involves a curandero sweeping a raw
chicken egg over the body of a victim to absorb the power of the person with
the evil eye. The egg is later broken into a glass and examined. The shape of
the yolk is thought to indicate whether the aggressor was a man or a woman.
It is widely believed in Mexico that at the time that the evil eye drains the
soul from a victim, the perpetrator can easily return it by passing his or her
hand over the forehead of the victim.

In the traditional Hispanic culture
of the Southwestern United States and some parts of Mexico, the cure for mal de
ojo may be slightly different. An egg is passed over the patient and
then broken into a bowl of water. This is then covered with a straw or
palm cross and placed under the patient's head while he or she sleeps.
The shape of the egg in the bowl is examined in the morning by a curandero
to determine whether or not the cure has been successful.

Aire

In personalistic medical systems, bewitching is often thought to be a cause of changed behavior or illness.
Bewitching involves the use of magical acts and supernatural powers either by
humans or supernatural beings. This may involve
sympathetic magic,
contagious magic, or simply
the casting of a spell. An example of bewitching occurs among the indigenous Nahua Indians of Central
Mexico. They believe that a particular kind of supernatural being can cause
an illness called aire (literally "air" in Spanish). These beings
are "rain dwarfs." They are about 1½ feet tall
and are thought to be made almost entirely of water. As a result they
are essentially invisible.
They cause aire by breathing on people. The typical symptoms of
this illness may include paralysis, a twisted mouth, palsy, pimples, and
aching joints. The first two symptoms are consistent with a stroke.
Aire is cured traditionally by a curandero cleansing the victim
by rubbing the body with herbs and an unbroken chicken egg.

In
traditional Hispanic communities of the Southwestern United States, aire
is usually not thought to be caused by bewitching. Rather, it attributed to
a rapid change from a hot to a very cold environment. Ear aches in
children are believed to be a consequence. Similarly, paralysis of one
side of the face or muscle spasms in adults are thought to be caused by
aire. To treat an ear ache, warm smoke is blown into it.
Muscle spasms are treated by "cupping". This involves heating the air in
a cup with a flame to cause it to expand and drive out excess air. The
cup is then placed over the site of the pain. As the air within the cup
cools it creates a vacuum which pulls on the skin.